Natural therapies for psoriatic disease

If Julie Cerrone, 30, of Pittsburgh, skips her fish oil for even a day, her body immediately makes her aware of it.

“I’ll feel run down, almost flu-like, and my joints will be very stiff,” said Cerrone, who was diagnosed with psoriatic arthritis three years ago but is convinced she has had it since she was a child. As a result of her personal experience with the disease and her work as a health coach, Cerrone considers herself a huge proponent of using certain natural therapies for treating her psoriasis and psoriatic arthritis.

It’s a different story for Todd Bello, of Stony Brook, New York. Bello has had psoriasis since he was 28 and psoriatic arthritis since he was 35. Now 52, he has tried a multitude of vitamins and supplements to treat his psoriatic conditions over the years, but none has done the trick for him.

So can natural therapies really help psoriatic disease? The answer on the patient side is reflected in the experiences of Bello and Cerrone — some say yes, some say no.

Doctors, too, have mixed opinions about their use and whether they can help provide relief from some symptoms. Dr. Nancy J. Anderson, director of the Psoriasis and Phototherapy Unit and a professor of dermatology at Loma Linda University Medical Center in Loma Linda, California, believes that natural therapies, or complementary and alternative medicines, can have a place in the treatment of psoriatic disease in some patients.

“Some people respond wonderfully, but every individual I treat with psoriasis is unique and responds differently,” she said, adding that evidence that vitamins and supplements such as fish oil and curcumin can help reduce inflammation — and thus symptoms — is largely anecdotal.

“We, as physicians, like to see more scientific evidence,” she said.

Dr. Mark Lebwohl, chairman of the department of dermatology at Mount Sinai School of Medicine in New York, finds the lack of scientific evidence proving the effectiveness of vitamins, minerals and herbs for psoriatic disease disconcerting.

He answers the question about the effectiveness of natural therapies with another. “Where’s the scientific evidence?”

Lebwohl also has concerns that some natural therapies could be harmful to patients.

“Years ago, Chinese herbs were promoted for psoriasis,” he said. “It turned out they contained steroids which, in the long run, are harmful.”

Differences in patient experiences

Much of the evidence supporting natural therapies is anecdotal, and patient experience varies widely.

Cerrone has no doubt that her joints are looser and less painful as a result of her daily mega doses of fish oil. (She takes mega doses because of a blood-clotting disorder.)

Fish oil has been shown to reduce inflammation and joint stiffness, according to The Arthritis Foundation. The best source is fatty fish, such as salmon, but it’s hard to get enough in your diet to be effective, Anderson said.

Cerrone also has found probiotics (live microorganisms that are intended to have health benefits) have helped her tremendously. She said consuming certain foods and probiotic supplements helps her stomach issues and gets her immune system working the way it should. She’s not surprised it’s working for her “because 70 to 80 percent of your body’s immune cells live in your gut,” she said, citing research from the National Center for Biotechnology Information.

Caroline Carroll, 58, of Los Angeles, was diagnosed with psoriasis 25 years ago and with psoriatic arthritis a year ago, and has tried food-based supplementation for a number of years. She drinks a green smoothie made of dark leafy greens, fresh turmeric, fresh ginger, cinnamon, fermented flax/chia seeds, fresh aloe vera and kefir every day. She also consumes a clove of raw garlic with a meal daily and believes her supplement routine complements her medications.

“My theory is my anti-inflammatory diet and supplements give the medications I take a kick-start,” she said.

Bello, however, hasn’t been as successful with his attempts at natural therapies. For a while, he thought all the vitamins and supplements he took when he was off medication were helping clear his skin and relieve his joint pain.

“I was so hopeful,” he said. “I spent a lot of money on these products.”

His regimen included vitamin D, ginseng, ginger, flax seed (a source of omega 3 fatty acids) and probiotics. But after more than a year, he realized his natural regimen wasn’t working and that he needed to see his doctor for medication. “I gave it the old college try, but I can’t say that supplements are a remedy for psoriasis,” he said.

Today, he is doing well on a biologic.

Talk to your doctor about potential risks

Always talk to your doctor before beginning a natural therapy regimen. If you’re already using a natural remedy and your doctor doesn’t know, tell him or her immediately, as supplements can interfere with some medications. Fish oil, for example, is a blood thinner and can pose a danger for those who are taking blood thinners such as Coumadin (warfarin), according to the NCCIH.

Anderson said she has seen patients develop a rash as a result of using creams containing aloe vera. Because many supplements are sold over the counter, patients often don’t realize they are medications and that they need to keep their medical team informed, she said. Women who are pregnant or nursing need to be especially careful.

The quality of the natural supplements also can be an issue. Under the Dietary Supplement Health and Education Act of 1994, the U.S. Food and Drug Administration regulates dietary supplements under a different set of regulations than those covering “conventional” foods and drug products.

Cerrone does her research to make sure the supplements she buys are of the highest quality and contain only the ingredients they say they do on their labels, she said, adding that she avoids those with gluten and chooses only supplements free of genetically modified organisms.

Anderson cautions that if a supplement isn’t bringing the results you expect, it could just take time.

“My experience is that it can take months to see improvement with herbs and other supplements,” she said.

And after several months, if you still aren’t experiencing change, don’t take a higher dosage than recommended in the hope that it will increase effectiveness. Higher dosages could result in overdose, “and you don’t know what side effects could occur,” Anderson said.

The bottom line is that, for some people, natural remedies may be worth exploring.

“But talk to your doctor before adding any natural supplements to your routine,” Anderson stressed. “Your doctor’s advice should be first and foremost.”

Natural supplements that show promise

Limited studies show support for some natural therapies for psoriasis and psoriatic arthritis. Among them:

Fish oil: Fish oil contains omega-3 fatty acids, which the body converts into anti-inflammatory chemicals. A study of 30 patients by researchers in Spain published in Clinical, Cosmetic and Investigational Dermatology in 2011 found that the group given two fish oil capsules daily for eight weeks showed clear improvement in their plaque psoriasis.

Curcumin: Psoriasis and psoriatic arthritis are both linked to systemic inflammation, and curcumin, the active ingredient in the Indian spice turmeric, has been shown to have an anti-inflammatory effect on the body. A study published in the January-February 2013 issue of the journal BioFactors found that curcumin works in several ways to help improve a number of inflammatory diseases.

Probiotics: A study published in January 2015 in Arthritis & Rheumatology found that people diagnosed with psoriatic arthritis had less abundant bacteria in their gut. Common products such as yogurt and some milks contain probiotics, and probiotics also are available as supplements. Scientists are still studying whether probiotics could one day become part of a psoriasis treatment. In the meantime, patients interested in probiotics should discuss the topic with their doctor. You can also read about the National Center for Biotechnology Information's research on probiotics.

Vitamin D: This is used in many effective topical treatments for psoriasis, and while we don’t know that dietary supplements of vitamin D and sunlight have the same effect, healthy levels of vitamin D are generally considered by medical doctors to be important for overall health and skin health.

The National Psoriasis Foundation does not endorse or recommend any products, medications, therapies or diets for the treatment of psoriasis or psoriatic arthritis.

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